Endoscopic Internal Drainage Achieving Successful Closure of Iatrogenic Pharyngoesophageal Fistula.

Endoscopic internal drainage (EID) is a minimally invasive endoscopic technique that effectively closes upper gastrointestinal fistulas. We report the successful closure of an oropharyngeal fistula in a 78-year-old man with a history of supraglottic squamous cell carcinoma. He presented with inspiratory stridor after biopsy of a lateral wall lesion in the piriformis sinus. Imaging showed a fistula tract between the piriformis sinus and the esophagus. EID was performed using a double-pigtail stent inserted inside the fistula. Eventually, repeat imaging showed evidence of fistula closure. To our knowledge, this is the first reported case of using EID for repairing an oropharyngeal fistula.

Interstitial Granulomatous Dermatitis as the Initial Manifestation of Granulomatosis with Polyangiitis.

Interstitial granulomatous dermatitis (IGD) is a rare dermatological disorder. It is most commonly associated with autoimmune disorders mainly lupus and rheumatoid arthritis. It has rarely been reported to present as a first manifestation of an underlying vasculitis. Here, we present a case of a 44-year-old woman who presented initially with a violaceous rash starting in her neck and trunk and extending to her limbs, but sparing the palms and soles. She was also found to have an acute kidney injury. A biopsy of the skin lesion confirmed the diagnosis of IGD, and a kidney biopsy showed findings consistent with granulomatosis with polyangiitis. To the best of our knowledge, this is the seventh reported case of IGD associated with systemic vasculitis.

Alcohol Use and the Risk of Colorectal Liver Metastasis: A Systematic Mapping Review.

The consumption of alcohol has long been associated with the development of liver disease as well as cancers including colorectal cancer (CRC). Leading healthcare concerns include the prevalent use of alcohol and the high burden of CRC mortality. Many CRC deaths are attributed to the development of colorectal liver metastasis (CRLM) as the liver is the foremost site of CRC spread. However, an association has not been defined for the role of alcohol intake and related liver injury with the development of CRLM. Here, a mapping review of recent research was undertaken to evaluate the relationship between alcohol consumption and the risk of CRLM. The literature search revealed 14 articles meeting the inclusion criteria that included patient database analyses and preclinical studies. Most of the human data analyses found alcohol use independently associates with worse CRC outcomes. The preclinical evaluations identified several pathways involved in the alcohol-mediated promotion of CRLM burden and CRC cell metastatic behavior. The limited number of studies identified exposes a significant need for more prospective analyses to define the role of alcohol intake and advanced CRC as well as the translation of preclinical research to fully characterize targetable mechanisms for the generation of new therapeutic options.

Blastomycosis Presenting as a Primary Tracheal Tumor: A Rare Presentation.

Blastomycosis is a rare fungal infection that typically presents as a pulmonary infection. Systemic involvement of blastomycosis from the lungs commonly occurs in the skin and bones. Tracheal involvement is an unusual presentation of blastomycosis, which makes it a formidable diagnostic challenge. We herein report an unusual case of an 85-year-old man presenting with tracheal blastomycosis presenting as a primary tracheal tumor. We also highlight the challenges that were faced in the diagnosis of such an uncommon presentation. To the best of our knowledge, this is only the third occurrence of blastomycosis with tracheal involvement.

Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report.

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

Urothelial carcinoma of the fossa navicularis successfully treated with laser ablation and distal urethrectomy: A case report.

Primary urothelial carcinomas very rarely arise from the fossa navicularis of the penis. They are rarely reported in the literature, with only 13 cases reported thus far. Herein, we present the case of a 34-year-old man with bloody urethral discharge due to a mass detected by cystourethroscopy in the fossa navicularis. Biopsy confirmed the diagnosis of noninvasive urothelial carcinoma. The patient was managed successfully with two sessions of holmium laser ablation, followed by distal urethrectomy. After the treatment, the patient's erectile function and continence were preserved, and no tumor recurrence was observed after 1 year of follow-up.

COVID-19-associated mortality across the countries of the Gulf Cooperation Council and how it compares to Europe: A comparative study.

INTRODUCTION: In late 2019, a novel strain of coronavirus, discovered in the city of Wuhan, China, was found to cause a disease later named coronavirus disease 2019, or COVID-19. In January 2020, COVID-19 first reached the Gulf region. Afterwards, the disease spread rapidly across the countries of the Gulf and the number of COVID-19 cases rose significantly. Now, more than a year later, there are only a limited number of studies regarding COVID-19 and its behavior in this region. In this article, we aim to assess the mortality caused by the disease in the Gulf region by calculating the Case Fatality Rates (CFR) for all of the Gulf Cooperation countries and comparing the results with those of Europe. METHODS: Data was obtained from the official statistics of the World Health Organization (WHO) from January to May 2020. From the data, the CFR was calculated for every Gulf and European country included in the study. Following the calculation, the results were compared and analyzed. To make our comparison more accurate, we added the total number of COVID-19 tests per 1000 population and the Health Access and Quality index for each individual country. RESULTS: CFRs in the Gulf region to May 12, 2020 were: United Arab Emirates (1.06%), Kuwait (0.69%), Saudi Arabia (0.62%), Oman (0.45%), Bahrain (0.15%), and Qatar (0.06%). Within Europe over the same time period, 10 countries had CFRs above 10%, with the majority above 3%. CONCLUSIONS: Compared to Europe, the COVID-19 mortality rate in the Gulf region has been much lower. The difference in age groups between the Gulf region and Europe may be the most important factor, mainly due to a younger population and a smaller elderly demographic in the Gulf region. Although age is a strong factor for the lower CFR in the Gulf, other factors must also be considered. These include the number of COVID-19 tests conducted per population, different country capabilities, and varying criteria for reporting COVID-19 deaths(Table-1)(Table-2).

Talar neck non-union in an athlete successfully treated with a synthetic bone graft: A case report.

Talar neck non-union is a rare complication of talar neck fractures. No guidelines are currently available for the proper management of this complication; thus, it can be hard for orthopaedic surgeons to successfully treat. Here we are reporting a case of talar neck non-union occurring in a 22-year-old male patient after a road traffic accident and presented to our institution 10 months after the initial injury. The non-union was managed surgically with an open reduction and internal fixation with the use of a synthetic bone graft to fill the defects. The patient regained full function and remained without complications after 7 years of follow up.

Successful Radiofrequency Ablation of an Atrial Flutter in an Elderly Patient With Uncorrected Ebstein's Anomaly.

Ebstein's anomaly is a rare congenital heart disorder that causes displacement of the tricuspid valve towards the apex of the heart. Patients with this anomaly rarely survive beyond the age of 70 without surgical correction. When such patients survive till adulthood, they tend to present with atrial arrhythmias. Although radiofrequency ablation is harder to successfully complete due to disrupted anatomy of the heart, it can be the best choice for terminating arrhythmias in such patients. Here, we present a case of a 76-year-old patient with an uncorrected Ebstein's anomaly that presented with atrial flutter and was treated successfully with radiofrequency ablation.

An examination of soil and water conservation practices in the paddy fields of Guilan province, Iran.

This study examined the use of soil and water conservation (SWC) practices among rice farmers in Iran. A random sample of 400 rice paddy farmers in the Foumanat plain of Guilan province, who use SWC measures, was drawn from a population of 52 thousand farmers. A two-part questionnaire was used to examine the level of utilization of SWC practices and to profile paddy farmers. Internal consistency was demonstrated with a coefficient alpha of 0.76, and the content and face validity of the instrument was confirmed by a panel of soil and water experts. Descriptive and analytical statistics were used to analyze the data. Results of ANOVA indicated that the mean levels of SWC practices vary considerably at the 0.01 level of significance by groups of age, education, non-agricultural income, production costs, yield, cultivated paddies and distance from home to the farm or to the main road. Similarly, significant differences were observed by groups of family size, rice production, ownership of livestock and profits from rice production at 0.05 level. The levels of experience in agriculture and ownership of poultry were found to have no significant effects on SWC practices.